A qualitative examination of the implementation of a perinatal collaborative care program

Abstract

Aim: To identify implementation strategies for collaborative care (CC) that are successful in the context of perinatal care. Background: Perinatal depression is one of the most common complications of pregnancy and is associated with adverse maternal, obstetric, and neonatal outcomes. Although treating depressive symptoms reduces risks to mom and baby, barriers to accessing psychiatric treatment remain. CC has demonstrated benefit in primary care, expanding access, yet few studies have examined the implementation of CC in perinatal care which presents unique characteristics and challenges. Methods: We conducted qualitative interviews with 20 patients and 10 stakeholders from Collaborative Care Model for Perinatal Depression Support Services (COMPASS), a perinatal collaborative care (pCC) program implemented since 2017. We analyzed interview data by employing the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to organize empirically selected implementation strategies from Expert Recommendations for Implementing Change (ERIC) to create a guide for the development of pCC programs. Findings: We identified 14 implementation strategies used in the implementation of COMPASS. Strategies were varied, cutting across ERIC domains (eg, plan, educate, finance) and across EPIS contexts (eg, inner context – characteristics of the pCC program). The majority of strategies were identified by patients and staff as facilitators of pCC implementation. In addition, findings show opportunities for improving the implementation strategies used, such as optimal dissemination of educational materials for obstetric clinicians. The implementation of COMPASS can serve as a model for the process of building a pCC program. The identified strategies can support the implementation of this evidence-based practice for addressing postpartum depression.

Perinatal Psychopharmacology: Innovative Approaches to Care Delivery

“…8 Ob clinicians may feel unsure of how to ask patients about related thoughts or behaviors, what questions to ask to assess safety, and how to triage their acuity level. 6 They may also feel that they do not have enough time in their clinic schedule to adequately address the patient's concerns. 6 These obstacles can be overcome by tools and protocols that guide a provider through performing a safety assessment.…”

“…6 They may also feel that they do not have enough time in their clinic schedule to adequately address the patient's concerns. 6 These obstacles can be overcome by tools and protocols that guide a provider through performing a safety assessment. The support from a collaborating psychiatric clinician is also instrumental, as they can provide consultation in the development of safety planning workflows, perform safety assessments directly (if available), and/or see patients for sooner evaluations than can be offered through external referrals.…”

“…Fortunately, implementation strategies have been identified that support the effective adaptation of the CCM into the perinatal context. 6 Specifically, the use of CCM billing codes, assessing for readiness, facilitating the relay of clinical data to providers, revising professional roles, and developing educational materials have all been described as facilitators of pCCM uptake. The effectiveness of the pCCM, built using these implementation strategies, has also been evaluated in one effectiveness-outcomes study.…”

“…Another barrier to Ob-psychiatric clinician collaboration is provider discomfort with high-acuity psychiatric symptoms, such as suicidal ideation or homicidal ideation 8 . Ob clinicians may feel unsure of how to ask patients about related thoughts or behaviors, what questions to ask to assess safety, and how to triage their acuity level 6 . They may also feel that they do not have enough time in their clinic schedule to adequately address the patient’s concerns 6 .…”

“…While the integration of mental health care into Ob and Gyn practice will be multifaceted, this chapter focuses on psychopharmacologic treatment. Supports to expand an Ob clinician’s role in initiating and monitoring evidence-based and indicated psychiatric medications are prioritized, as mental health care delivered within Ob care is patient-centered, accessible, and best aligns with patients’ preferences 6 . However, Ob clinicians will care for patients with PMH conditions across a spectrum of acuity and complexity, and Ob and psychiatric clinicians can collaborate to create a cohesive continuum of psychopharmacologic care for perinatal patients.…”